The report comes after the expansion of Medicaid health benefits under the Affordable Care Act survived several attempts by the Republican-led Congress and the Donald Trump White House to take away health coverage from poor people. “2017 marked the year that Medicaid moved to the forefront of the national conversation, as perception -- and politics -- caught up with the reality that no other social welfare program touches more Americans,” PwC’s Ari Gottlieb, the report’s author, wrote in the 17-page analysis released at this week’s Medicaid Health Plans of America annual meeting.

Managed-care plans continue to take on an unprecedented role in providing health coverage to poor Americans thanks in part to more states opting to go along with the ACA’s Medicaid expansion. There have been 31 states that have expanded Medicaid under the ACA and Maine will vote next Tuesday on whether to become the 32nd state to do so.

PwC said 73% of Medicaid beneficiaries -- or 54.8 million of the 74.8. million Americans covered by the health benefit program for the poor -- are enrolled in private plans that contract with the Medicaid program. That's an increase of 1.5% from last year's report that showed 53.7 million people in private Medicaid plans.

Though total enrollment in Medicaid increased by just 98,000, or about one-tenth of a percentage point, the share managed by private insurers is rising as states shift more of their Medicaid population to managed care plans. This is good news for health insurance companies like Aetna, Anthem, Centene, Humana, UnitedHealth Group and Blue Cross and Blue Shield plans.

Growth of Medicaid managed-care is coming from states where governors and state legislatures are moving, generally in a bipartisan fashion, to private administration of the government program.

Among the states with “sizable increases in private share” include Missouri, West Virginia and Nevada. Other states, including Illinois, are moving more private management of Medicaid in the coming months.

“PwC’s new report shows that state enrollment in Medicaid has begun to slow because of the good economy,” Jeff Myers, CEO of Medicaid Health Plans of America said. “However, it also demonstrates that states are continuing to find ways to have Medicaid health plans carry more risk in more populations. It shows the confidence states have in the managed care model to provide access to quality health care while maintaining budget predictability.”